Before the presentation, I want to talk about full thickness all-in-side, quadtendo, in several places. As we know, the ACL has a length of 25-35mm, a width of 10-11mm, and two functional bands. And the purpose of this ACL reconstruction is to reproduce the 90-80% of the NITO ACL. At the graph selection, we have several options, like VTV, hamstring, and quadtendom. As we know, the VTV ACL standard has a cross-sectional area of 4.8mm, versus quadriceps has a cross-sectional area of 10.2mm. And this paper by Serógenes showed that quadriceps tendons had higher load-to-failure than VTV. In 2014, this paper showed that almost 11% of the surgeons around the world use quadriceps tendons. Talking about histology, this paper by Pessler showed that quadtendons had 20% more collusion than VTV. We use full-thickness quadriceps tendons since 1999, like what was described by Dr. Lulito in the arthroscopy. The first use for the quadriceps tendons was described by Fulkerson in 1995. This is our graph. We use one block, so we have the length enough without disrupting the vascular medullae. We also use the graph a little smaller than the tendinous part. In this video, we can see how we can take the graph. First, we can make a vertical or horizontal incision, we cut the osseous part, and then we make it with the tendinous part, without disrupting, as we said before, the vascular medullae. In this video, we can see how, after extracting the quadriceps tendon, we have good inter-articular vision. Since 2012, we use all-in-thigh full-thickness quadriceps tendons. With the femoral tunnel, we made it anatomic, anteromedial portal. We always use it over the top, and we drill a 35mm femoral tunnel. For the tibial tunnel, we use a retrodriver. In this case, we use a flick cutter so we don't punch out the tibial cortical. Then we pass the graph, and we fix it in the femur with an interference screw, and in the tibia with a 1-1 retro screw. This is our reconstruction. We have the possibility to fix the quad tendon in the tibia with a cortical fixation, so we put the tendinous part in the tibia, and the bone block in the femur. This is a one-case report, 21 years old, soccer player, no comorbidity. This is a physical exam, hyperextension, pivot and lagman positive, nothing to show in the regs. This MRI, the relation of the ACL, no meniscal lesion, no collateral ligament lesion. In this case of a soccer professional player, we use a quad tendon plus a late articular augmentation. This is a post-op, and this is a lady returning to the sport. Between 2007 and 2020, we made 1728 ACL reconstruction. Of these, 105 were professional soccer players, average age 21 years, follow-up of two years. We evaluated this patient with lesion, EKDC, KT-1000, the percentage of re-raptor. The lesion pre-co was 64 points, and after two years follow-up, more than 94 percent of percentage have excellent or good results, similar results in EKDC. The stability measure by KT-1000, the difference between the contral knee was average 1.1 millimeters. 87 percent of the patient has less than 3 millimeters, and only 4 percent have more than 5 millimeters. Talking about re-raptor, it's well-known in the literature that the age is a risk factor for the re-raptor, so we separate the re-raptor into groups under 20 or over 20. In the group under 20, we have two re-raptors who represented 10 percent of the patients. I want to show this paper as a long systematic review. We evaluated 14 papers, level evidence 1, 2, or 3. They compare stability between squat, hamstring, and BTV, and there are no difference in stability in Leitman test, in PO-CHIF, on anterior-posterior laxity. Talking about functional outcomes, only Khortchovsky showed better results in EKDC in the BTV group, but no in the other papers, and there are no difference in lesion score. Talking about complication, there are no difference in complication, but about the morbidity, especially knee anterior pain, there are big difference between quad and BTV. In quad tendon, the knee anterior pain is between 5 to 15 percent, and in the BTV, 18 to 51 percent. So like Lance said in that paper, the quad system is a good option because it has similar results to BTV according to stability, according to functional score, but less anterior knee pain and less sensitive loss. And to the end, I want to show a little to the editor, like Dr. Freddy Fu, the versatility of the quad tendon, because you can use it for simple bundle, double bundle, for ACL, for PCL, with or without one block. Thank you very much.

full-thickness quadriceps tendons

ACL reconstruction surgery

histological benefits

tendon graft

Dr. Freddy Fu